Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 2085R0202X | Radiology | Diagnostic Radiology | 3054017 | PENNSYLVANIA | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 8853701 | OTHER | | CIGNA |
| 2 | ========= | OTHER | | TRICARE STANDARD |
| 3 | ========= | OTHER | | FIRST HEALTH |
| 4 | 03272900 | OTHER | | CAPITAL BLUE CROSS |
| 5 | ========= | OTHER | | BCBS HORIZON OF NJ |
| 6 | PA178 | OTHER | | ONE CALL MEDICAL |
| 7 | VA1366772 | OTHER | | HIGHMARK |
| 8 | 1522296 | OTHER | | GATEWAY |
| 9 | 2684292 | OTHER | | AETNA US HEALTHCARE |
| 10 | ========= | OTHER | | NJ MANUFACTURERS INS |
| 11 | P00021587 | OTHER | PENNSYLVANIA | RAILROAD MEDICARE |
| 12 | 1367521 | OTHER | | MEDIGAP BLUE SHIELD |
| 13 | ========= | OTHER | | DEVON |
| 14 | 1366772 | OTHER | | INDEPENDENCE BC PPO |
| 15 | ========= | OTHER | | PRIVATE HEALTHCARE SYSTEM |
| 16 | 001894533 | MEDICAID | PENNSYLVANIA | |
| 17 | 053223 | MEDICARE PIN | PENNSYLVANIA | |
| 18 | 130512 | OTHER | | MEDPLUS THREE RIVERS |
| 19 | ========= | OTHER | | UNITED HEALTHCARE |
| 20 | ========= | OTHER | | MULTIPLAN |
| 21 | ========= | OTHER | NEW JERSEY | HORIZON BLUE CROSS BLUE SHIELD OF NEW JERSY |
